Propofol expert testifies next in trial of Michael Jackson's doctor

Dr. Conrad Murray's defense team believes Michael Jackson may have injected himself with a fatal dose of the surgical anesthetic propofol.

STORY HIGHLIGHTS

Anesthesiologist Dr. Steven Shafer may be the prosecution's last witness

A cardiologist testifies Michael Jackson would be alive today if Dr. Murray called 911 quicker

Murray is guilty even if Jackson injected himself with the fatal dose, an expert says

Using propofol for sleep is "beyond comprehension," a sleep expert testifies

Los Angeles (CNN) -- An anesthesiologist will testify Thursday that Dr. Conrad Murray's treatment of Michael Jackson was so grossly negligent that it was criminal, an opinion that echoes two other medical experts called to testify by prosecutors Wednesday.

Dr. Steven Shafer, who may be the last witness called before the prosecution rests its case in Murray's involuntary manslaughter trial, is expected to echo the testimony of a cardiologist and a sleep expert who took the stand Wednesday.

Murray's delay in calling 911 for help as soon as he realized Jackson was not breathing may have cost the pop icon his life, according to cardiologist Dr. Alon Steinberg.

Steinberg and Dr. Nader Kamangar, a UCLA sleep expert, both presented a long list of what they said were instances of Murray's extreme deviation from the standards of medical care, including his failure to immediately call for paramedics.

"If these deviations would not have happened, Mr. Jackson would be alive," Steinberg testified.

The Los Angeles County coroner ruled that Jackson's June 25, 2009, death was from "acute propofol intoxication" in combination with several sedatives, including lorazepam.

Murray's lawyers contend that Jackson used a syringe to inject the fatal overdose through a catheter on his left leg while Murray was away from his bedside. They dropped the theory pushed earlier that Jackson may have orally ingested propofol that the coroner says killed him.

Murray's defense also contends that Jackson swallowed eight tablets of lorazepam, a sedative, in a desperate search for sleep the day he died.

Murray should be found guilty even if jurors accept the theory that Jackson self-administered the fatal dose because the doctor was reckless for leaving propofol and lorazepam near his patient when he was not around, Steinberg testified.

"It's like leaving a baby that's sleeping on your kitchen countertop," Steinberg said. "There's a very small chance the baby could fall over, or wake up and grab a knife or something."

Steinberg said he based his conclusions on Murray's own words to detectives in an interview two days after Jackson's death. That interview was played for jurors in the previous two days of the trial.

Jackson would be alive today if Murray had called 911 for help within two minutes of realizing Jackson was not breathing, instead of waiting about 20 minutes before asking a security guard to call, Steinberg said.

Earlier testimony revealed Murray did ask Jackson's chef to send a security guard upstairs to help him about five minutes after the time prosecutors suggest he realized there was a problem with Jackson. The chef, however, testified that she sent Jackson's 12-year-old son upstairs instead of security.

Steinberg said the use of propofol to treat Jackson's insomnia was another extreme deviation from standards that contributed to Jackson's death. He later acknowledged a recent report from China that the anesthetic had been successfully used to treat chronic insomnia, but he suggested it needed more study to be accepted.

Kamangar, the sleep expert, testified later Wednesday that propofol has no therapeutic value in treating insomnia, and to use it is unethical and an extreme deviation from the standards of care.

Steinberg said he based his conclusions on his belief that Murray had connected Jackson to an IV drip of propofol after he gave him an injection of propofol. That assumption, he said, was made because Murray told police he had used such a drip on most previous nights.

When Flanagan challenged him to show where in Murray's police interview he said he used a drip the day Jackson died, he eventually said "I will agree with you, it's not completely clear."

Steinberg also said it was gross negligence that Murray was not prepared for an emergency, such as having a generator in case there was a power failure.

Murray told detectives he gave Jackson a series of three sedatives -- Valium, lorazepam and midazolam -- over a 10-hour period before finally giving in to Jackson's plea for propofol.

"I've got to sleep, Dr. Conrad," Murray said Jackson pleaded to him. "I have these rehearsals to perform. I must be ready for the show in England. Tomorrow I will have to cancel my performance, because you know I cannot function if I don't get to sleep."

Murray said he injected a small dose of propofol using a syringe, but the prosecution contends he also used a makeshift IV setup to keep Jackson medicated and asleep. That drip may have malfunctioned while the doctor was not monitoring his patient, they contend.

The prosecution has been unable to produce the tubing that would be a critical piece of an IV system, although they did show jurors an opened saline bag into which they contend Murray placed an opened propofol bottle.

On the recording, Murray insisted he kept a close watch on Jackson after he finally fell asleep. The physician never mentioned the long list of e-mails and calls that cell phone records later revealed.

Murray was hired as Jackson's personal physician while the singer prepared for his "This Is It" comeback concerts in London, planned to start in July 2009.

If convicted of involuntary manslaughter, Murray could spend four years in a California prison and lose his medical license.